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Abstract
Malignant mesothelioma of the testicular tunics is rare. About one third of cases are metastatic and carry a poor prognosis. This paper reviews the epidemiology, clinicopathologic features, treatment, and outcome of this entity.
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Mesothelioma of the tunica vaginalis testis. Hum Pathol 2019; 92:48-58. [DOI: 10.1016/j.humpath.2019.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022]
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Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health 2019; 18:78. [PMID: 31470859 PMCID: PMC6717382 DOI: 10.1186/s12940-019-0512-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/05/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy. METHODS A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here. RESULTS Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos. CONCLUSIONS The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
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Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol 2017; 27:348-359.e11. [PMID: 28527639 DOI: 10.1016/j.annepidem.2017.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/10/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant mesothelioma most commonly arises in the pleura and peritoneum but also occurs rarely at other anatomical sites with mesothelial tissue, namely, the pericardium and tunica vaginalis testis (TVT). This review provides a better understanding of the epidemiology of mesothelioma of these extrapleural sites. METHODS We conducted a systematic review of the epidemiologic and clinical literature on pericardial mesothelioma and mesothelioma of the TVT. We also analyzed U.S. Surveillance, Epidemiology, and End Results cancer registry data to describe incidence patterns of these malignancies. RESULTS An etiologic role of asbestos exposure has been hypothesized for pericardial and TVT mesotheliomas, but no analytical case-control epidemiologic studies exist to test this relationship. A substantial proportion of cases with these malignancies report no known asbestos exposure. In large occupational cohorts with heavy asbestos exposures, no cases of pericardial or TVT mesothelioma have been reported. Trends in the incidence of these malignancies do not match those of pleural mesothelioma, which correspond to historical trends of commercial asbestos use. A male preponderance of pericardial mesothelioma is not evident. CONCLUSIONS In the absence of analytic epidemiologic studies, the etiologic role of environmental risk factors for mesothelioma of the pericardium and TVT remains elusive.
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Affiliation(s)
- Gabor Mezei
- Health Sciences Center, Exponent, Inc., Menlo Park, CA.
| | - Ellen T Chang
- Health Sciences Center, Exponent, Inc., Menlo Park, CA
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Maheshwari PN, Abiola OO, Wagaskar VG, Oswal AT. Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature. Urol Ann 2017; 9:110-112. [PMID: 28216946 PMCID: PMC5308028 DOI: 10.4103/0974-7796.198877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hydrocele is a very common condition that is simple to evaluate and treat. Management of hydrocele is usually delegated to the junior members of the surgical team. Sometimes this simple condition can spring huge surprises. A 20-year-old man presented with acute onset large, painless fluctuant left hemi-scrotal swelling. Scrotal ultrasonography showed thickened tunica vaginalis. A diagnosis of left hydrocele was made and repair by excision of sac was planned. During the procedure, the sac was found studded with red nodular growths; histopathology reported malignant mesothelioma of tunica vaginalis. Metastatic evaluation showed extensive retroperitoneal lymph nodal involvement. Despite receiving adjuvant chemotherapy with radiotherapy patient died due to extensive metastasis within 16 months. This case is presented for rarity of diagnosis, young age of presentation, absence of etiological factor and rapidly progressive clinical course.
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Affiliation(s)
| | - Olajide O Abiola
- Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Vinayak G Wagaskar
- Department of Urology, Seth G.S. Medical College and Hospital, Mumbai, Maharashtra, India
| | - Ajay T Oswal
- Department of Urology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
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Yen CH, Lee CT, Su CJ, Lo HC. Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis? World J Surg Oncol 2012; 10:238. [PMID: 23140511 PMCID: PMC3506562 DOI: 10.1186/1477-7819-10-238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/26/2012] [Indexed: 11/20/2022] Open
Abstract
A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.
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Affiliation(s)
- Ching-Heng Yen
- Division of Urological Surgery, Department of Surgery, Song-Shan Armed Forces General Hospital, No, 131, JianKang Rd,, SongShan Dist,, Taipei City, 105, Taiwan
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Priester P, Kopecký J, Prošvicová J, Petera J, Zoul Z, Slováček L. Cutaneous Recurrence of Malignant Mesothelioma of the Tunica Vaginalis Testis: a Rare Case Report. ACTA ACUST UNITED AC 2012; 35:46-8. [DOI: 10.1159/000335884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Paratesticular mesotheliomas are rare tumors with 223 cases described so far. The sole plausible causative factor so far ascertained in the pathogenesis of these tumors is asbestos, which however is found in only around 30% to 40% of such cases. The age range of affected individuals is wide, mostly adults and the elderly, but also includes young people and children. The most common presenting symptom is either hydrocele of unknown origin or intrascrotal mass. When hydrocele is the presenting symptom, these tumors are often clinically overlooked and the diagnosis is delayed. Most paratesticular mesotheliomas arise in the tunica vaginalis, but primary tumors of the spermatic cord and epididymis are also on record. Tumors arising from the peritoneal mesothelium of a hernia sac are excluded from this group. The correct diagnosis is almost always made after histologic examination of the operative specimen. Immunohistochemistry and electron microscopy are always helpful and sometimes necessary tools for diagnosis. So far very few cases have been identified or suspected preoperatively on cytologic examination. Three clinicopathologic types of malignant mesotheliomas of the male genital tract are recognized: diffuse tubulo-papillary mesothelioma, well-differentiated papillary mesothelioma, and multicystic mesothelioma. The histologic subtypes are almost always pure epithelial or biphasic. The differential diagnosis is mainly with serous papillary tumors arising from Mullerian vestiges, but several diverse primary or secondary tumors also need to be considered. A clinicopathologic evaluation of a case of tunical diffuse mesothelioma in a 74-year-old male from the AMR Series is the starting point for this general review.
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Ikegami Y, Kawai N, Tozawa K, Hayashi Y, Kohri K. Malignant mesothelioma of the tunica vaginalis testis related to recent asbestos. Int J Urol 2008; 15:560-1. [DOI: 10.1111/j.1442-2042.2008.02036.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Malignant mesothelioma of the gonads is a rare and highly lethal disease. Most of these tumors arise from the tunica vaginalis, which is a continuation of the mesothelium similar to the pleura and the peritoneum. However, intratesticular and ovarian mesotheliomas have also been described. Occasionally, patients with localized disease at the time of detection have been known to survive for more than 10 years; however, the majority will not live beyond 5 years, with median survival being approximately 23 months. The principle reasons for this are difficulty in making a preoperative diagnosis and advanced stage at the time of treatment. Surgery forms the mainstay of management for all stages of the tumor. Adjuvant therapy in the form of chemotherapy, immunotherapy, or radiotherapy has negligible benefit. It is essential to diagnose this rare entity at the early stages to allow complete surgical extirpation. For the management of localized disease, we suggest the following protocol: initial staging of suspected cases with computed tomographic scan of the abdomen and pelvis; radical inguinal orchiectomy or hemiscrotectomy; retroperitoneal lymph node dissection in cases with positive nodes on scan or biopsy; and inguinal node dissection in cases requiring hemiscrotectomy. For advanced or recurrent disease, we suggest local radical resection with chemotherapy, including high-dose cisplatin and doxorubicin for two cycles of 5 days each; add local radiotherapy for uncontrolled locally advanced disease.
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Affiliation(s)
- Narmada P Gupta
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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